The intra-extracardiac Fontan: preliminary results

Talwar, Sachin; Sengupta, Sanjoy; Choudhary, Shiv Kumar

doi:10.1007/s12055-019-00862-7

Cited by 3 publications

(10 citation statements)

References 32 publications

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“…The risk of compression of the pulmonary veins by the conduit, which may be an important problem in ECF is eliminated in IECF 30 . The path of the conduit is far away from sinoatrial node and the right atriotomy is more limited, which may have additive effect on decreased incidence of arrhythmias in IECF, as well 26 …”

Section: Discussionmentioning

confidence: 99%

“…Lateral tunnel modification is traditionally known to cause atrial arrhythmias. However, the ECF technique, which was advocated in the early 1990s as a solution for rhythm disturbances in patients with LT is not innocent as well 26 . Transection of IVC and suturing the atrial cuff near terminal crest/Eustachian valve in ECF modification is speculated to damage the atrial conduction pathways and lead to arrhythmia in long term 26 .…”

Section: Discussionmentioning

confidence: 99%

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Early outcomes of fenestrated intra‐extracardiac Fontan procedure: Insights, experiences, and expectations

Şimşek

Özyüksel

Demiroluk

et al. 2022

Journal of Cardiac Surgery

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Background: Intraextracardiac Fontan procedure (FP) aimed to combine the advantages of lateral tunnel and extracardiac conduit modifications of the original technique. Herein, we present our early outcomes in patients with intraextracardiac fenestrated FP.Methods: A retrospective analysis was performed to evaluate intraextracardiac fenestrated Fontan patients between 2014 and 2021. Seventeen patients were operated on with a mean age and body weight of 9.1 ± 5.5 years and 28.6 ± 14.6 kg.Results: Sixteen patients (94%) were palliated as univentricular physiology with hypoplasia of one of the ventricles. One patient (6%) with well-developed two ventricles with double outlet right ventricle and complete atrioventricular septal defect had straddling of the chordae prohibiting a biventricular repair. All of the patients had cavopulmonary anastomosis before Fontan completion, except one case. Fenestration was performed in all cases. Postoperative mean pulmonary artery pressures and arterial oxygen saturation levels at follow-up were 10 ± 2.4 mmHg and 91.3 ± 2.7%, respectively. Mean duration of pleural drainage was 5.4 ± 2.3 days. All of the fenestrations are patent at a mean follow-up period of 4.8 ± 7.7 years, except one case. Any morbidity and mortality were not encountered.Conclusions: Early outcomes of intraextracardiac fenestrated FP are encouraging. This procedure may improve the results in a patient population who should be palliated as univentricular physiology, especially in cases with complex cardiac anatomy.cavopulmonary anastomosis, congenital heart disease, Fontan procedure, single ventricle 1 | INTRODUCTION Fontan procedure (FP) has been performed as the common destination treatment for patients with single ventricle physiology, since it was defined in the early 1970s. At first, Dr. Francis Fontan defined this surgical procedure by performing an atriopulmonary connection in three patients with tricuspid atresia, which was the prototype of true single ventricle morphology. 1 Following the first years of FP, many modifications were defined as well as the indications of this palliative procedure were extended. Apart from single ventricle morphology, cases in which satisfactory septation could not be achieved such as double outlet right ventricle (DORV) with a remote ventricular septal defect (VSD), FP was the procedure of choice. 2Probably, there has been no other palliative surgical procedure other than the Fontan circulation in the historical development of congenital heart diseases that had significant modifications with

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early outcomes of fenestrated intra‐extracardiac Fontan procedure: Insights, experiences, and expectations

Şimşek

Özyüksel

Demiroluk

et al. 2022

Journal of Cardiac Surgery

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“…Another important feature of IECF is decreased incidence of arrhythmias in long-term follow-up (26). Rhythm disturbances in FP patients may lead to decreased cardiac output, AV valve regurgitation, thrombus formation in cardiac chambers and syncope (27).…”

Section: Discussionmentioning

confidence: 99%

“…The lateral tunnel modification is traditionally known to cause atrial arrhythmias. However, the ECF technique, which was advocated in the early 1990's as a solution for rhythm disturbances in patients with LT is not innocent as well (26). Transection of IVC and suturing the atrial cuff near terminal crest/Eustachian valve in ECF modification is speculated to damage the atrial conduction pathways and lead to arrhythmia in long term (26).…”

Section: Discussionmentioning

confidence: 99%

“…However, the ECF technique, which was advocated in the early 1990's as a solution for rhythm disturbances in patients with LT is not innocent as well (26). Transection of IVC and suturing the atrial cuff near terminal crest/Eustachian valve in ECF modification is speculated to damage the atrial conduction pathways and lead to arrhythmia in long term (26). Therefore, preservation of terminal crest and Eustachian valve and eliminating the sutures at the atrial cuff makes the IECF technique superior to LT and ECF with regard to incidence of arrhythmia (27,28).…”

Section: Discussionmentioning

confidence: 99%

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Mid Term Results of Fenestrated Intra-Extracardiac Fontan Procedure: Insights, Experiences and Expectations

Özyüksel¹,

Şimşek²,

Demiroluk³

et al. 2021

Preprint

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Background: Intraextracardiac Fontan procedure aimed to combine the advantages of lateral tunnel and extracardiac conduit modifications of the original technique. Herein, we present our experience in our patients with intraextracardiac fenestrated Fontan Procedure. Methods: A retrospective analysis was performed in order to evaluate intraextracardiac fenestrated Fontan patients between 2014 and 2021. Seventeen patients were operated on with a mean age and body weight of 9.1 ± 5.5 years and 28.6 ± 14.6 kg. Results: Sixteen patients (94%) were palliated as univentricular physiology with hypoplasia of one of the ventricles. One patient (6%) with well-developed two ventricles with double outlet right ventricle and complete atrioventricular septal defect had straddling of the chordae prohibiting a biventricular repair. All of the patients had cavopulmonary anastomosis prior to Fontan completion, except one case. Fenestration was performed in all cases. Postoperative mean pulmonary artery pressures and arterial oxygen saturation levels at follow up were 10 ± 2.4 mmHg and 91.3 ± 2.7 %, respectively. Mean duration of pleural drainage was 5.4 ± 2.3 days. All of the fenestrations are patent at a mean follow up period of 4.8 ± 7.7 years, except one case. Any morbidity and mortality were not encountered. Conclusions: The mid-term results of intraextracardiac fenestrated Fontan procedure are encouraging. This procedure may improve the results in a patient population who should be palliated as univentricular physiology, especially in cases with complex cardiac anatomy.

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Fontan Completion in Adult Patients with Functionally Univentricular Hearts

Alpat,

Aydin,

Aykan

et al. 2024

Thorac Cardiovasc Surg

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Background: Although there are considerable amounts of data on the outcomes of pediatric patients who have undergone Fontan repair, little is known about having Fontan completed in adulthood. The study presented the midterm results of our unit's experience with the Fontan completion procedure in adult patients with functionally univentricular hearts. Methods: Between 2014-2023, 16 adult patients underwent total cavopulmonary connection completion. Relevant information was retrospectively collected. Results: 16 patients with a median age of 19 years (18–21 years) were included. Median arterial oxygen saturation was 76% (70–80.75%), and 62.5% of the patients were NYHA Class-III. The median mean pulmonary artery pressure was 14 mmHg (9.5–14.5 mmHg). Nine patients (56%) had heterotaxy syndrome, and the median time between the last operation and total cavopulmonary connection was 15.5 years (6.75–17.5 years). The median durations for bypass and cross clamp were 160 minutes (130–201 minutes) and 120 minutes (84.5–137.5 minutes), consecutively. The postoperative course was straightforward in all. The median arterial oxygen saturation before discharge was 89.5 % (85-90%), and 68.75% of the patients were NYHA Class-II. Follow-up was complete for all patients with a median of 24 months. There was no early or late mortality or significant morbidity during the study period. Conclusions: We concluded that the intra-extracardiac fontan technique was feasible for meticulously selected adults undergoing total cavopulmonary connection completion, as evidenced by an acceptable mortality rate and a satisfactory mid-term outcome, including improvements in their NYHA functional class. However, the long-term consequences must be monitored.

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The intra-extracardiac Fontan: preliminary results

Cited by 3 publications

References 32 publications

Early outcomes of fenestrated intra‐extracardiac Fontan procedure: Insights, experiences, and expectations

Early outcomes of fenestrated intra‐extracardiac Fontan procedure: Insights, experiences, and expectations

Mid Term Results of Fenestrated Intra-Extracardiac Fontan Procedure: Insights, Experiences and Expectations

Fontan Completion in Adult Patients with Functionally Univentricular Hearts

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